title: Adding familial risk assessment to faecal occult blood test can increase the effectiveness of population-based colorectal cancer screening.
abstract: BACKGROUND
  The Dutch Health Council recently recommended the introduction of a colorectal cancer (CRC) screening programme by faecal occult blood testing (FOBT) for individuals aged 55-75 at population risk of CRC. Individuals at an increased familial CRC risk (≥ 2 times population risk) should be identified at a younger age, so they and their relatives can receive earlier, more intensive surveillance instead of FOBT.
  
  
  OBJECTIVE
  To determine the percentage of participants with a positive FOBT in a CRC screening programme with an increased familial CRC risk.
  
  
  METHODS
  In a population-based study, 10,569 individuals aged 50-75 received an FOBT. Individuals with a positive FOBT were invited for colonoscopy and familial risk assessment. Participants with an average familial CRC risk were compared to those with an increased risk. Increased familial CRC risk was defined as a cumulative lifetime risk of CRC of at least 10%.
  
  
  RESULTS
  Of 6001 participants, 430 had a positive FOBT, of whom 324 (63% males; mean age 63 years) completed colonoscopy and familial risk assessment. CRC (n=22) and/or advanced adenomas (n=122) were found in 133 participants. Familial CRC risk was increased in 6% of participants with a positive FOBT. No significant differences were found between participants with an average versus an increased familial CRC risk.
  
  
  CONCLUSIONS
  Six percent of participants with a positive FOBT had an increased familial CRC risk. Identifying at-risk participants enables them and their relatives to undergo regular colonoscopies. Adding familial risk assessment to FOBT screening may thus prevent a substantial number of CRCs.
authors.affiliation: Department of Human Genetics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: N
authors.initials: N
authors.lastname: Dekker
authors.forename: L G M
authors.initials: LG
authors.lastname: van Rossum
authors.forename: M
authors.initials: M
authors.lastname: Van Vugt-van Pinxteren
authors.forename: S H C
authors.initials: SH
authors.lastname: van Stiphout
authors.forename: R P M G
authors.initials: RP
authors.lastname: Hermens
authors.forename: W A G
authors.initials: WA
authors.lastname: van Zelst-Stams
authors.forename: M G H
authors.initials: MG
authors.lastname: van Oijen
authors.forename: R J F
authors.initials: RJ
authors.lastname: Laheij
authors.forename: J B M J
authors.initials: JB
authors.lastname: Jansen
authors.forename: N
authors.initials: N
authors.lastname: Hoogerbrugge
mesh_terms: D000368:Aged; D003113:Colonoscopy / Q000379:methods; D015179:Colorectal Neoplasms / Q000097:blood* / Q000175:diagnosis* / Q000235:genetics; D055088:Early Detection of Cancer / Q000379:methods*; D005189:False Positive Reactions; D005192:Family Health; D005243:Feces; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008495:Medical Oncology / Q000379:methods; D008875:Middle Aged; D009780:Occult Blood; D012306:Risk; D018570:Risk Assessment